Extrahepatic arteries of the human liver - anatomical variants and surgical relevancies

Abstract

SummaryThe purpose of our study was to investigate the anatomical variations of the extrahepatic arterial structures of the liver with particular attention to rare variations and their potential impact on liver surgery. A total of 50 human abdominal organ complexes were used to prepare corrosion casts. A multicomponent resin mixture was injected into the abdominal aorta. The portal vein was injected with a different colored resin in 16 cases. Digestion of soft tissues was achieved using cc. KOH solution at 60-65°C. Extrahepatic arterial variations were classified according to Michels. All specimens underwent 3D volumetric CT reconstruction. Normal anatomy was seen in 42% of cases, and variants were seen in the other 58%. No Michels type VI or X variations were present; however, in 18% of cases the extrahepatic arterial anatomy did not fit into Michels' classification. We report four new extrahepatic arterial variations. In contrast to the available data, normal anatomy was found much less frequently, whereas the prevalence of unclassified arterial variations was higher. We detected four previously unknown variations. Our data may contribute to the reduction of complications during surgical and radiological interventions in the upper abdomen.

Hepatic artery classification based on three-dimensional CT

“…Many hepatic artery variants described in the CRL classification could not be defined in Michels' or Hiatt's classification. Neglecting aberrant hepatic arteries may increase the risk of iatrogenic injury to the aberrant arteries and result in liver ischaemia, biliary ischaemia, liver abscess or biliary–enteric anastomotic failure. For instance, most of the blood supply to the extrahepatic biliary tree comes from the RHA or rRHA.…”

Replaced gastroduodenal artery: Added benefit of the “artery first” approach during pancreaticoduodenectomy—A case report

“…Michels found that standard extrahepatic arterial anatomy occurs in 55–60% of individuals based on results of 200 autopsies. Recent meta-analyses and large volume surgical, radiological, and post-mortem anatomical studies including up to 12,000 cases each, reported an extrahepatic arterial anatomic variation ranging from 10% to 42% [8] , [9] , [10] , [11] , [12] , [13] .…”

Gastroduodenal artery: single key for many locks

“…An aGDA has not been reported in literature. In a meta-analysis of CA variations which included 12,000 cases from 36 studies, there was no mention of a replaced GDA (rGDA) [2,7]. Many other studies have identified frequency of variations in origin of rGDA, summarised in Table 1 [14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…A thorough knowledge of arterial anatomy and its variations is a key prerequisite for safe hepatopancreaticobiliary (HPB) surgery . So frequent are arterial variations that it is impossible to consider any one anatomical description as normal .…”